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Health financing and payment, results-based financing, social protection, conditional cash transfer programs, noncommunicable disease, maternal and child health
Amanda Glassman is chief operating officer and senior fellow at the Center for Global Development and also serves as secretary of the board. Her research focuses on priority-setting, resource allocation and value for money in global health, as well as data for development. Prior to her current position, she served as director for global health policy at the Center from 2010 to 2016, and has more than 25 years of experience working on health and social protection policy and programs in Latin America and elsewhere in the developing world.
Prior to joining CGD, Glassman was principal technical lead for health at the Inter-American Development Bank, where she led policy dialogue with member countries, designed the results-based grant program Salud Mesoamerica 2015 and served as team leader for conditional cash transfer programs such as Mexico’s Oportunidades and Colombia’s Familias en Accion. From 2005-2007, Glassman was deputy director of the Global Health Financing Initiative at Brookings and carried out policy research on aid effectiveness and domestic financing issues in the health sector in low-income countries. Before joining the Brookings Institution, Glassman designed, supervised and evaluated health and social protection loans at the Inter-American Development Bank and worked as a Population Reference Bureau Fellow at the US Agency for International Development. Glassman holds a MSc from the Harvard School of Public Health and a BA from Brown University, has published on a wide range of health and social protection finance and policy topics, and is editor and coauthor of the books Millions Saved: New Cases of Proven Success in Global Health (Center for Global Development 2016), From Few to Many: A Decade of Health Insurance Expansion in Colombia (IDB and Brookings 2010), and The Health of Women in Latin America and the Caribbean (World Bank 2001).
The international family planning community has made impressive gains in increasing global access to high-quality, voluntary family planning services. However, significant challenges remain with maintaining current support and meeting the growing need projected for family planning services and commodities across low- and middle-income countries (LMICs).
Each year, delegations representing all World Health Organization (WHO) Member States attend the World Health Assembly (WHA) to determine the policies and budget of the organization. In advance of this year's WHA, the Center for Global Development will convene a curtain-raiser event to highlight topics and controversies on the WHA agenda -- from universal health coverage (UHC) and its measurement to the role WHO might play vis-à-vis global partnerships and funders and the alignment of global priorities.
Over 1 billion women lack access to financial services due to economic and social barriers, time and mobility constraints, and discrimination in service provision. Financial services delivered digitally can address these barriers by providing women with safe and accessible channels. This event will look at the recent evidence and emerging technologies that work to empower women economically.
Independent policy research organizations – or think tanks – play a potentially important role in translating evidence to action, lending both technical expertise and an objective evidence base to help strengthen policy behind people-centered health systems in the developing world. This panel will highlight successful and less successful efforts by think tanks around the world to bridge the gap between health systems research and policy impact, with emphasis on tried and tested strategies as well as “bloopers” that unite researchers, activists, practitioners and policy-makers and can be utilized in a variety of settings. Panelists will describe a specific experience and debate the issues related to driving a research agenda from concept to conclusion to policy impact, highlighting what worked – and what didn’t – along the way.
Despite improvements in censuses and household surveys, the building blocks of national statistical systems in sub-Saharan Africa remain weak. Measurement of fundamentals such as births and deaths, growth and poverty, taxes and trade, land and the environment, and sickness, schooling, and safety is shaky at best. The Data for African Development Working Group’s recommendations for reaping the benefits of a data revolution in Africa fall into three categories: (1) fund more and fund differently, (2) build institutions that can produce accurate, unbiased data, and (3) prioritize the core attributes of data building blocks.
Decisions about which type of patients receive what interventions, when, and at what cost often result from ad hoc, nontransparent processes driven more by inertia and interest groups than by science, ethics, and the public interest. Reallocating a portion of public and donor monies toward the most cost-effective health interventions would save more lives and promote health equity.
Update: OCHA’s Financial Tracking Service publishes information on humanitarian assistance in response to emergencies worldwide. In the case of Ebola, some funding announced by donors in recent months has been in the form of long-term development assistance, loans, or other forms of financing. As such, it is not included in the OCHA Financial Tracking Service database. The FTS database is updated daily, so numbers may vary from the publication of this blog post.
How much is actually being spent on Ebola by donor governments, organizations, and private individuals? The short answer is that we don’t really know.
We do know that the US government, the World Bank, and others are committing large amounts of money to Liberia, Guinea, and Sierra Leone through various channels such as the World Health Organization, UNICEF, the CDC, and bilateral aid to affected country governments. We also have UN OCHA’s Financial Tracking service, which is publishing regular updates with donors’ Ebola contributions.
However, compared to the pledges made in press releases, UN OCHA’s numbers come up short for several donors, as of October 24, 2014. The figure below illustrates this discrepancy, with the differences amounting to as much as $391 million in the case of the US government. The World Bank has committed up to $400 million, but UN OCHA’s database only accounts for around $197 million of this, even accounting for uncommitted pledges.
Why this discrepancy between actual commitments and press announcements? One explanation is that the additional spending by governments goes through channels that UN OCHA’s financial tracking service does not cover. For instance, US allocations to the Department of Defense and Health and Human Services do not appear in the OCHA database, although their funding to USAID does. While this may be an explanation for the bilateral aid from country donors, the discrepancy between World Bank’s press and OCHA numbers is harder to pinpoint. Similarly, there are cases where press announcements seem to understate the actual spending and commitments by donors: Sweden appears to have funded and committed $37 million more than its last press announcement, whereas China has funded and committed $25 million more than it has announced (not shown in figure).
Better data and more accountability needed
The importance of reliable information about donor contributions in the aftermath of a crisis cannot be overstated. In an ongoing crisis, reliable and accurate information helps donors decide how to allocate funding in order to avoid overlap. However, it is difficult to assure accountability when it is impossible to match the total amounts in the press announcements with the actual money that has been allocated and spent in these countries.
UN OCHA’s overview of needs and requirements, which should serve as a real-time check for future commitments, has pinned the immediate needs and requirements across the region at $988 million. It also shows that spending and commitments on Ebola total $1.4 billion as of October 24; according to press releases of commitments for the top 20 donors, the total funding and pledges amount to more than $2.4 billion. Either way, the immediate needs seem to have been exceeded, and donors now need to think ahead for how best to allocate funds.
The lack of aid accountability in the aftermath of a crisis is an ongoing problem for the development community. The amount of aid given in the aftermath of Haiti’s 2010 earthquake is still difficult to quantify, and tracing US government funding down to the subcontractor remains next to impossible. A public health emergency such as the Ebola outbreak in West Africa faces largely similar risks when inflows of money are difficult to trace. Aid may be allocated inefficiently; contractors and subcontractors will not be held accountable for outcomes. Governments that already face the pressures of managing a developing economy often lack the infrastructure to manage these large inflows of cash. The onus for accountability therefore ought to be on the donors, not the recipient country governments that are in the midst of coping with an evolving emergency.
Releasing comprehensive, regular updates to the OCHA database would be a good first step, and should be considered a priority for all donors—if only to be sure that your press releases are accurate. But the UN OCHA database also needs to provide more detail about the allocation and use of funding to be most useful. Smarter allocation and greater accountability and evaluation are only possible if exact uses, locations, and recipients are known.
Global health action has been remarkably successful at saving lives and preventing illness in many of the world’s poorest countries. This is a key reason that funding for global health initiatives has increased in the last twenty years. Nevertheless, financial support is periodically jeopardized when scandals erupt over allegations of corruption, sometimes halting health programs altogether.
Despite improvements in censuses and household surveys, the building blocks of national statistical systems in sub-Saharan Africa remain weak. Measurement of fundamental statistics such as births and deaths, growth and poverty, taxes and trade, land and the environment, and sickness, schooling, and safety is shaky at best.
Millions Saved (2016) is a new edition of detailed case studies on the attributable impact of global health programs at scale. As an input to the book, this paper provides an independent assessment of the cost-effectiveness of a selection of the cases using ex post information from impact evaluations, with the objective of illustrating how economic evaluation can be used in decision making and to provide further evidence on the extent of health gains produced for the funding provided.
Many health improving interventions in low-income countries are extremely good value for money. So why has it often proven difficult to obtain political backing for highly cost-effective interventions such as vaccinations, treatments against diarrhoeal disease in children, and preventive policies such as improved access to clean water, or policies curtailing tobacco consumption?
As Latin American countries seek to expand the coverage and benefits provided by their health systems under a global drive for universal health coverage (UHC), decisions taken today – whether by government or individuals – will have an impact tomorrow on public spending requirements.
Across multiple African countries, discrepancies between administrative data and independent household surveys suggest official statistics systematically exaggerate development progress. We provide evidence for two distinct explanations of these discrepancies.
Amid debate about whether adolescent pregnancy is a problem in and of itself or merely symptomatic of deeper, ingrained disadvantage, this paper aggregates recent quantitative evidence on the socioeconomic consequences of and methods to reduce of teenage pregnancy in the developing world.
This paper examines opportunities for improved efficiency in malaria control, analyzing the effectiveness of interventions and current trends in spending. Overall, it appears that resources for malaria control are well spent—however, there remain areas for improved efficiency, including (i) improving procurement procedures for bed nets, (ii) developing efficient ways to replace bed nets as they wear out, (iii) reducing overlap of spraying and bed net programs, (iv) expanding the use of rapid diagnostics, and (v) scaling up intermittent presumptive treatment for pregnant women and infants.